Question 1

A 43-year-old male has fallen from a roof and cannot move or feel his arms or legs. When assessing the patient, which one of the following signs would lead the EMT to suspect the patient is suffering from spinal shock?

Accepted Answer

Spinal shock is a temporary loss or decrease of reflexes below the level of the injury. It can last up to 48 hours and can cause a decrease in heart rate, blood pressure, and respiratory rate. A heart rate of 68 beats per minute may be an indicator of spinal shock as it is lower than the patient's normal heart rate. Cool and moist skin, cyanosis to the fingertips, and seizure activity are not necessarily indicative of spinal shock.

Question 2

You have been called to a public building for a 32-year-old male patient who fell down a flight of stairs. As you pull up, he walks to the ambulance and states that he would like to be looked at because his shoulder and lower back hurt. You immediately take in-line manual spinal stabilization and examine his back, which reveals no sign of injury. How should you immobilize this patient?

Accepted Answer

The answer of You have been called to a public...

Question 3

The EMT should recognize a possible spinal column injury with no spinal cord involvement when he discovers what assessment finding?

Accepted Answer

Tenderness to the thoracic spine with intact motor and sensory to each extremity is indicative of a possible spinal column injury with no spinal cord involvement. This is because the injury is limited to the bony structures of the spine and not affecting the spinal cord itself. This finding is often referred to as a "spinal bony injury." Options B, C, and D all involve either a loss of motor or sensory function in one or more extremities, which suggests spinal cord involvement.

Question 4

A minivan has struck a utility pole and is on fire. The driver is unresponsive and has life-threatening injuries. Which one of the following would be most appropriate when extricating the patient from the vehicle?

Accepted Answer

Rapid extrication with cervical collar applied is most appropriate in this scenario to quickly remove the unresponsive driver with life-threatening injuries from the immediate danger of the fire, while also taking precautions to protect the cervical spine.

Question 5

Which one of the following shows that the EMTs are correctly using a vest-type short spine immobilization device?

Accepted Answer

The correct sequence for using a vest-type short spine immobilization device is to secure the torso first, then the head, and then secure the legs. Therefore, the EMTs are correctly using the device if the head is secured to the device after the torso has been secured, which is the case in option D. Applying the cervical collar before securing the torso (option A) or securing the head before the torso (option B) is incorrect use of the device. Option C is also incorrect, as the head should not be secured to the device immediately after the cervical collar is placed, as the torso must be secured first.

Question 6

You and your partner are preparing to extricate a patient from a car using a vest-type short spine immobilization device. After ensuring that in-line manual spinal stabilization is being maintained, your next instruction should be:

Accepted Answer

Checking the patient's motor, sensory, and pulses in the arms and legs is crucial before beginning any extrication procedure. This helps identify any potential spinal cord injuries or nerve damage that may have occurred during the accident. Once this is done, the cervical collar should be applied before moving the patient onto the backboard and placing the vest. Turning the patient toward the door of the car may contribute to spinal movement, which should be avoided.

Question 7

The EMT is properly assessing for a spinal cord injury when she:

Accepted Answer

Asking the patient to spread his fingers apart on both hands assesses motor function and can help identify potential spinal cord injuries affecting the nerves that control hand movement.

Question 8

An EMT is rapidly extricating a critically injured patient from a severely damaged vehicle. Which one of the following would the EMT recognize as acceptable given this patient's condition?

Accepted Answer

In this scenario, the EMT should prioritize rapid extrication of the patient over the use of a long backboard. However, a cervical collar and manual in-line spinal stabilization are still required to prevent further spinal injury during the extrication process. The use of a vest-type or other short spine immobilization device can be omitted as it may slow down the extrication process.

Question 9

A football player was struck in the head and is complaining of a headache and nausea. He also states that he has pain to his upper back and tingling in his left hand. The EMT is providing proper care for the patient when he:

Accepted Answer

Leaving the helmet in place helps to stabilize the head and neck while the face mask can be removed to allow for better assessment of the airway and breathing. Removing the shoulder pads or not placing the patient on a long board is not mentioned as necessary in this situation.

Question 10

A male patient fell 20 feet from a cliff to a trail below. The primary assessment shows him to be confused, with an open airway and shallow breathing. His pulse is 72 beats per minute and his blood pressure is 78/50 mmHg. The skin is warm and flushed. The patient has no motor ability or sensation in his legs. Which one of the following is the most likely cause of this patient's presentation?

Accepted Answer

The patient falling 20 feet from a cliff is likely to have incurred a spinal injury, leading to the lack of motor ability and sensation in his legs. The blood pressure reading of 78/50 mmHg indicates hypotension, which may also result from spine damage. Confusion and shallow breathing may occur due to head trauma, which may also be present. Therefore, the most likely cause of the patient's presentation is a spinal injury.

Question 11

A window washer has fallen 20 feet from scaffolding while washing the windows on an office building. He is alert and oriented, but states that he cannot move or feel his legs. Additionally, because his blood pressure is 82/48 mmHg, you suspect spinal shock. What other assessment finding reinforces your suspicion of spinal shock?

Accepted Answer

Cool and clammy skin is a common sign of spinal shock, which occurs due to temporary disruption of spinal cord function. This disruption can lead to a decrease in blood pressure, heart rate, and the ability to sweat, causing cool and clammy skin. A heart rate of 144 and SpO₂ at 92% are possible indications of shock but are not typical of spinal shock specifically. Flushed and dry skin is not associated with spinal shock.

Question 12

A patient has just been log rolled and positioned onto the long backboard. Which one of the following care measures should be performed next?

Accepted Answer

After positioning the patient on the backboard, the next step is to secure the patient's chest with straps to ensure stability and prevent movement during transport.

Question 13

You pull up to the scene of a single-car motor vehicle collision. Emergency Medical Responders (EMRs) are maintaining in-line manual spinal stabilization of the 56-year-old driver who was unrestrained when she struck a tree at a high rate of speed. As you approach the vehicle, you note that she appears unresponsive with blood coming from her nose and ears. Which one of the following instructions to the EMRs is most appropriate?

Accepted Answer

The priority in this scenario is to ensure the patient's airway, breathing, and circulation are assessed and managed as quickly as possible due to the signs of significant injury (unresponsiveness and bleeding from the nose and ears). Placing a cervical collar for spinal immobilization and then moving the patient to a long board for further assessment and transport is a standard approach in managing potential spinal injuries in a trauma patient.

Question 14

A motorcyclist wearing a full helmet was thrown from his motorcycle after hitting a patch of oil. The bike had been traveling at a high rate of speed. Manual in-line spinal stabilization is being held by an off-duty EMT. The primary assessment reveals the patient to be responsive to painful stimuli and breathing rapidly. His radial pulse is weak and fast. As you quickly scan his body, you note deformity to the left femur and lower leg. Your immediate action should be to:

Accepted Answer

Removing the helmet is crucial to ensure proper airway management and to assess for any potential head injuries, especially since the patient is only responsive to painful stimuli and has rapid breathing.

Question 15

A male patient has suffered an injury that severed his spinal cord in the thoracic spine. What presentation would be associated with this injury?

Accepted Answer

Damage to the spinal cord in the thoracic region can cause paralysis below the level of injury, which can include the legs. This is because the thoracic region is responsible for spinal nerves that control the lower parts of the body. Injuries to higher levels of the spinal cord may affect sensation and motor function in the arms. Pain below the level of injury is also a possibility, but it is more commonly associated with injuries to the cervical or lumbar spine. decreased motor ability above the injury is less likely.

Question 16

You are maintaining manual in-line stabilization of the cervical spine for a patient being log rolled, transferred, and secured to a long backboard. At what point will you release the manual in-line spinal stabilization?

Accepted Answer

Manual in-line spinal stabilization should be maintained until the head, chest, and knees have been secured with straps. This helps to prevent any further movement or injury to the cervical spine during the transfer process.

Question 17

Which one of the following statements about removing a helmet in the prehospital setting is true?

Accepted Answer

Leaving a helmet on a patient is acceptable if the patient has no airway or breathing problems, as it can provide some level of immobilization and protection. Removing the helmet is necessary only if it interferes with the ability to manage the patient's airway or if it prevents proper spinal immobilization when such measures are required.

Question 18

A 2-year-old boy fell down a flight of stairs. Which instruction would you provide to other EMTs who are immobilizing the patient?

Accepted Answer

Placing a folded towel under the shoulders of a 2-year-old patient who fell down a flight of stairs will help maintain head alignment, which is important for preventing further injury or damage to the neck and spinal cord. Option A is incorrect because a towel should not be placed behind the head for a patient with a suspected neck or spinal cord injury. Option B is incorrect because a collar that is too big will not provide adequate support or immobilization. Option D is incorrect because a cervical collar alone is not sufficient for immobilizing a patient with a suspected neck or spinal cord injury.

Question 19

A high school football player was hit from behind and is complaining of severe back pain and numbness to his right leg. Manual in-line spinal stabilization is being maintained by an assistant coach. Once at the patient's side, what should you do next?

Accepted Answer

The first priority in a trauma patient is to always assess the airway and breathing to ensure adequate oxygenation and ventilation. In this case, the patient is complaining of severe back pain and numbness to his right leg, which could indicate spinal cord injury, so it is important to maintain manual in-line spinal stabilization. However, the airway and breathing must be quickly assessed to make sure the patient is stable before any transport or movement is attempted. Disconnecting the face mask or removing the helmet could potentially worsen spinal injury if not done correctly, and applying a cervical spine immobilization collar should only be done after the airway and breathing have been assessed.

Quiz 32: Spinal Column and Spinal Cord Trauma